Page 5 - Guide
P. 5
UnitedHealthcare (UHC) Pharmacy Program
Major Medical Plan Enhancements
Beginning on January 1, 2 new
pharmacy programs will go into
UHC ACA
Beneit In-Network Out-of-Network effect.
Deductibles and Maximums First, through the mail service
Individual $4,000 $8,000 member select program, you will
Family $8,000 $16,000 be required to ill maintenance
Out-of-pocket calendar year maximum (includes deductible, copays, and drugs using UHC’s home delivery
coinsurance) mail service, OptumRx. This
Individual $6,000 $12,000 program will require members
Family $12,000 $24,000 with maintenance medications
Lifetime beneit maximum Unlimited to participate in the OptumRx
Covered Services mail service. After 2 ills at a
Ofice visits retail pharmacy, you must move
Primary physician 80% after deductible 50% after deductible your maintenance prescriptions
Specialist 80% after deductible to OptumRx; however, you can
Preventive care 100% no copay disenroll from the program at
Emergency medical care any time by calling the number
Emergency room 80% after deductible 80% after deductible on your member ID card. When
Urgent care 80% after deductible 50% after deductible you move to OptumRx, you will
Ambulance 80% after deductible 80% after deductible receive a 3-month supply of your
Hospital services medication. The purpose of this
Inpatient services 80% after deductible 50% after deductible program is to help you receive
Outpatient services your maintenance drugs more
Prescription Beneits easily and at a lower cost. You will
Retail (up to 31 days) be notiied by UnitedHealthCare
In-network 80% after deductible if you are currently taking a
Out-of-network 80% after deductible
Mail (up to 90 days) maintenance drug which will
In-network 80% after deductible need to be illed through the mail
Out-of-network Not covered service member select program.
The second program is the step
UHC Plan Weekly Contribution Rates therapy program, which helps you
Employee * $28.50 ind less expensive but equally
Employee + child(ren) $245.17 effective medications before you
* If you earn below $10.00 an hour, please contact Human Resources for your weekly select more expensive non-
contribution amount. preferred medications.
5
Major Medical Plan Enhancements
Beginning on January 1, 2 new
pharmacy programs will go into
UHC ACA
Beneit In-Network Out-of-Network effect.
Deductibles and Maximums First, through the mail service
Individual $4,000 $8,000 member select program, you will
Family $8,000 $16,000 be required to ill maintenance
Out-of-pocket calendar year maximum (includes deductible, copays, and drugs using UHC’s home delivery
coinsurance) mail service, OptumRx. This
Individual $6,000 $12,000 program will require members
Family $12,000 $24,000 with maintenance medications
Lifetime beneit maximum Unlimited to participate in the OptumRx
Covered Services mail service. After 2 ills at a
Ofice visits retail pharmacy, you must move
Primary physician 80% after deductible 50% after deductible your maintenance prescriptions
Specialist 80% after deductible to OptumRx; however, you can
Preventive care 100% no copay disenroll from the program at
Emergency medical care any time by calling the number
Emergency room 80% after deductible 80% after deductible on your member ID card. When
Urgent care 80% after deductible 50% after deductible you move to OptumRx, you will
Ambulance 80% after deductible 80% after deductible receive a 3-month supply of your
Hospital services medication. The purpose of this
Inpatient services 80% after deductible 50% after deductible program is to help you receive
Outpatient services your maintenance drugs more
Prescription Beneits easily and at a lower cost. You will
Retail (up to 31 days) be notiied by UnitedHealthCare
In-network 80% after deductible if you are currently taking a
Out-of-network 80% after deductible
Mail (up to 90 days) maintenance drug which will
In-network 80% after deductible need to be illed through the mail
Out-of-network Not covered service member select program.
The second program is the step
UHC Plan Weekly Contribution Rates therapy program, which helps you
Employee * $28.50 ind less expensive but equally
Employee + child(ren) $245.17 effective medications before you
* If you earn below $10.00 an hour, please contact Human Resources for your weekly select more expensive non-
contribution amount. preferred medications.
5
